Tidbits for YOUR Pearly Whites

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In carpentry, the first rule every beginner is taught is: MEASURE TWICE, CUT ONCE! Similarly, dentistry requires the same attention to detail. If one follows my preceding three dental “Commandments“, the prognosis for their teeth can be pretty solid long-term.

For most dental patients, I recommend that they have needed dental work accomplished in as few steps as possible–Do it once; do it the right way the first time in order to avoid multiple procedures. For example, if a tooth needs a crown (Commandment #3), then I may be able to patch it with a filling, but will have to treat the tooth again in the future to protect it with a crown. Treating a tooth twice means twice the risk of injury to the nerve in the root canal of the tooth–since every time a tooth is damaged, infected or restored (“filled”), the nerve inside the tooth is injured/inflamed and must heal. That can happen only so many times before the tooth is irreparably damaged and gives up the ghost–leading to extraction.

I advise my patients that the amount of dental care they need will be directly proportional to the amount of dental work they needed (or should have had…) while in their teenage years. Every 20 years or so, they will need to have the dental work updated or replaced–just like those “20-year” shingles on a roof. Now, I can hear all the nay-sayers out there saying, “Ha! Well my dentist did a great job–my fillings have been there for almost 30 years.” To that, I say, “Please refer back to previously discussed Commandment #1 and Commandment #2, because nothing lasts forever and to maximize long-term predictability of dental care, one must be preemptive in its maintenance.

Figure 2–Before photos (2006)

Though the patched roof in Fig. 1 may not match or look as good as the original (it may be part of a long-term replacement plan by the owner), it should function well until the rest of the project can be completed. For the patient in Fig. 2 and 3, I created a phased treatment plan so that all the procedures needed for his extreme dental makeover (and thus the expenses!) were accomplished over a 7 year period to permit numerous travel opportunities for him and his wife and necessary delays to allow for orthodontic therapy, sinus augmentation and implant healing time. The important part was that he completed his goals on HIS time schedule; got the cosmetic and functional result he desired and each tooth was only restored once!

Fig. 3 Smile complete (2012)

The only time that a “phased” approach to care doesn’t make sense is when one or more teeth must be touched multiple times unnecessarily. It’s not a mandate, but merely advice to avoid increasing the risk of complications. Remember: Commandment #4 really means that the more times a tooth is touched, the more likely one is to lose the tooth! So, if you are in need of extensive dental care, ask your dentist if the option of a phased approach to care would be best for you. If your dentist cannot answer that question to your satisfaction, give my office a call and schedule a consultation appointment to discuss your needs–I’ll do my best to provide sound advice.

Either way: Do it once; do it the right way–the first time.

Until next time–Keep Smiling! Please check in again, or visit my website at:

Most of us learned in school that things expand and contract when exposed to changes in temperature. Bridge builders knew long ago that if they didn’t allow for it, a bridge would fall into the chasm when temperatures plummet in winter! Conversely, the bridge would buckle when exposed to the heat of summer. That’s why they have expansion joints–the familiar “cha-chunk, cha-chunk” when you drive your car on and off of a bridge.

Dentists have had to deal with this problem for years. Unfortunately, our patients don’t abide by the seasons! They expose their teeth to extremes of heat (coffee, soup, tea) and cold (ice cream, ice water, high-speed snow skiing!!) all the time. Have you ever been to a nice restaurant where the doting waiter offers you ice cream AND coffee for dessert?!? (Pity your poor teeth with those old silver fillings!) In fact, after ice and popcorn kernels, the most common cause of tooth fracture in my office over the years comes after Thanksgiving–“But, Doc, I was only eating mashed potatoes when it broke!” Of course, they were homemade–full of chunky, “hot-spots” that caused excessive expansion that broke off an already weakened piece of tooth.

Even more insidious is the contraction to cold. When the metal filling contracts, a microscopic gap opens to allow for fluids, bacteria and sugars to enter. The scary part is that this “leakage” is the reason that silver fillings work in the first place! The leakage of fluids permits oxidation (“rust”) that “seals” the natural space between the tooth and the silver filling. The end result, however, is recurrent tooth decay that weakens the tooth and/or leads to infection of the root canal–which is why even small fillings don’t last forever.

I advise patients that my “cut-off” for determination whether a tooth should be crowned or “just have a filling” is my 50% Rule:

When the volume of the filling exceeds 50% of the available, remaining healthy tooth structure, the tooth should be restored with a crown to minimize the risk of cracking the tooth when heat, chewing or clenching forces are applied.

These old silver amalgam fillings are accidents waiting to happen!

Of course, it is only a guideline. And, it doesn’t mean that treatment can’t be staged over time–it just increases the risk of fracture “while you wait.” I will usually offer my best “estimate of longevity” when a patient asks me, “How long can I wait?” But in my heart, I know my response should call to mind an age-old problem:

My crystal ball is broken, let’s use yours! 😉

If only life were that easy…

Until next time–Keep Smiling! Please check in again, or visit my website at:

The band, KANSAS, crooned: “Nothing lasts forever but the Earth and Sky.” As much as my patients wish otherwise, everything in dentistry (except extractions, of course!) has a finite lifespan, too. One can assume that the useful life of a typical filling will average somewhere between 10 – 15 years; it’s a “Bell Curve” like we all remember from the test grades in high school. Some may not make the average; some may stay in the tooth longer, but all will eventually develop recurrent decay due to leakage and/or break the tooth under the forces of clenching/chewing combined with the oxidation (“rust”) of the material. Materials that do not corrode will always last longest. The smaller the filling, the longer it lasts–and vice-versa.

Fig. 1. But the shingles are still there!

My patients know that I L-O-V-E! analogies. I seem to have one for almost every condition that presents in my office. Material breakdown/failure is a favorite topic. Everyone has seen an old barn like the one in Fig. 1 at some time in their lives. The shingles are still there, but the barn is destroyed underneath it–the shingles quit doing their job many years earlier!

Dental work is no different.

Fig. 2. This is NOT going to end well! Better to have patched that “little” hole before the structure is destroyed.

The dentist can identify and repair/restore small issues before they become big ones (see Fig. 2). Most patients don’t realize that the fillings that your parents had your dentist place for you as a teen (or you had done in your early adult years) were not meant to last forever, but rather, to “get you through” until the teeth are lost to gum disease, fracture, or extensive decay, or until you can afford to upgrade them to more permanent restorations that Mom and Dad won’t have to pay for…

Fig. 3: Attention and meticulous maintenance will result in long-lasting health, function and beauty in dentistry, too!

With a little luck and good health, you WILL outlive your dental work. So, to make the most of it, one must do the things that we consistently NAG our patients about: Floss and brush the teeth every night; cut out the excess sugar and acidic food and drink in the diet; see the dentist twice a year and abide by the 5 Commandments of Dentistry that are being discussed in my blog!

Until next time–Keep Smiling! Please check in again, or visit my website at:

After 25 years in practice– I have concluded that there are 5 simple guidelines that a patient needs to consider when confronted with the need for dental treatment. These guidelines apply across generations, across socio-economic statuses, across all the races, creeds and political strata!

My Five Commandments, or rather, my “5 Rules of Thumb” are as follows:

Five Commandments of Modern Dentistry

Be preemptive. “Yankee Mentality” serves no one well when it comes to your teeth!

It is my distinct pleasure to welcome my friends, patients and followers to my blog. It is my hope that I can address concerns that affect my patient family most often. I hope to share with you my love of the arts and sciences to which I have chosen to dedicate my life.

Since I was 5 years old, I’ve wanted to be a dentist. In fact, I never considered anything else! I often joke with my patients (and just about anyone who will listen!) that I went to kindergarten because they told me I couldn’t go to dental school without it.

I bring to my beloved profession a diverse background that includes a serious love of art, woodworking, chemistry, biology, medicine and psychology.

Dr. Bobbitt’s self-carved bed

These disciplines, plus a hefty dose of engineering, physics and plumbing, combined with a significant measure of common sense, all merge in my delivery of the best dental care of which I am capable in my downtown Nashua NH dental office. With an understanding of all these branches of learning, I have endeavored to provide the best and longest-lasting dental care for my patient family–whether that care be for general dentistry, dental implants, sleep apnea therapy or any of the disciplines of dentistry.

General dentistry permits me to apply a wide variety of experience, with the potential to be open-ended as a career. Please enjoy the snippets of experience that I hope to weave into a story that will interest you. If an item “strikes a nerve,” I will be happy to reply to you. If it makes you wonder: “Why didn’t my dentist tell me that?” please feel free to call my office for a face-to-face consultation.